Sexual and gender minority (SGM) adolescents are at disproportionate risk of poor health behaviors, experiences and outcomes compared to their straight, cisgender peers. SGM youth, however, are not a homogenous population; each has multiple social identities that affect the risk and protection they experience. Intersectionality refers to ways in which power and privilege are structured based on interrelated social positions (e.g. due to race/ethnicity, immigrant status, native language) and how individual experiences reflect processes that confer privilege and disadvantage. Mutually constitutive forms of social oppression (e.g., stigma simultaneously based on race/ethnicity, gender, and sexual orientation) may differentially affect the health of SGM people with multiple marginalized social positions. Living within these intersecting social positions may give rise to unique challenges as well as strengths that promote healthy development among youth. The landmark 2011 National Academy of Medicine (NAM) report on the health of SGM populations and additional recent reports have highlighted the need for health research using an intersectionality framework, explicitly including both risk and resilience, to inform interventions supporting SGM youth. Building on the nascent literature suggesting that Latino and Black/African American SGM youth might be at heightened risk, the proposed study responds to NOT-MD-19-001 and addresses the following research question regarding SGM adolescents (12-19 years old): 1) What are differences in bullying, risk behaviors, emotional distress, and protective factors among youth with different social positions (i.e. racial/ethnic groups, immigrant experiences, and native language)? 2) How do differences in protective factors and other characteristics explain differences in these outcomes among youth with different social positions? and 3) What positive and negative experiences are particularly relevant to the overlapping, simultaneous production of inequalities by SGM identity, race/ethnicity, immigration experiences, and native language? We will answer these questions with two study aims: First, conduct extensive analysis of three existing adolescent health datasets: the Minnesota Student Survey (N~122,000), California Healthy Kids Survey (N~1,042,000), and the LGBTQ National Teen Survey (N~17,000), which have different samples, demographic profiles, and measures. We will test multiple hypotheses using both harmonized and parallel analyses. Second, conduct qualitative interviews with 64-80 SGM youth from different social positions to more deeply understand quantitative findings and generate concrete, relevant recommendations for interventions. We will focus on up to four intersecting social positions where SGM youth face the greatest disparities, as identified in Aim A, and specific protective factors identified in Aim A will be the focus of interviews to ?dig deep? beyond brief survey measures. Qualitative findings will provide critical information on interpersonal and community assets for the most vulnerable SGM youth and how they can be bolstered for other young people.
Health disparities adversely affecting sexual and gender minority (SGM) adolescents and youth of color are well-documented. Stigmatizing experiences, institutionalized oppression, and lack of access to resources and services can engender emotional distress and unhealthy coping behaviors, and disparities are expected to be more pronounced for those with multiple marginalized social positions. This mixed methods study using an intersectional approach is directly responsive to the National Academy of Medicine report and the NIH?s call for research to advance the health of SGM populations; interventions built on the insights gleaned from this work will extend protective benefits across the SGM youth population and reduce persistent health disparities.